A comparison was made of the reliability and validity of two self-rating scales, the Children's Depression Inventory (CDI) and Depression Self-Rating Scale (DSRS), in the diagnosis of depression in 93 children (aged 8–16 years) attending a university child psychiatry department. The two scales were of comparable merit but had only moderate discrimination between depressed and non-depressed children, with each scale having a misclassification rate of 25%. Better agreement was obtained in more verbally intelligent children, irrespective of age. Girls scored higher on the instruments than boys. No significant relationship was found between teacher assessment of classroom behaviour and the two self-rating depression instruments.

A number of drugs capable of mono-amine oxidase inhibition have been marketed with the claim that they alleviate depressive illness. One of these is tranylcypromine (‘Parnate’), which has won notoriety on account of the severe headache experienced by those receiving the drug when they also eat ripe cheese (Lancet, 1964). In chemical structure, it is related to amphetamine. Amphetamine is a drug of addiction, and addiction to tranylcypromine was therefore to be expected. A preliminay notice of the present patient has already been published (Le Gassicke, 1962).

A sample of 26 HIV seronegative, 59 HIV seropositive asymptomatic and 7 HIV seropositive symptomatic homosexual and bisexual men were assessed over two visits, a mean of 11 months apart, using the BDI, STAI, and CIS. Significant differences emerged between the symptomatic group and the other two groups. Past psychiatric history and the somatic items in the assessments accounted for some of these differences. The seropositive asymptomatic and the seronegative groups did not differ on any of the mood or psychiatric assessments, suggesting minimal effect on psychological well-being of seroconversion in the absence of symptoms.

This paper is an attempt to fill the void in objective investigation into the personality factors of lesbians. Although the subject of male homosexuality has been investigated exhaustively, it was not until relatively recently that studies concerned with lesbianism have been published, beginning with Armon (1960), then Bene (1965), Kaye et al. (1967) and Kenyon's series of articles in 1968. These papers have all attempted to take the subject out of the myth and psychoanalytic theory stages and bring it into the light, to determine whether the many theories, which at times have been based upon knowledge gleaned from male homosexual studies, have any objective, quantifiable basis. For example, one view stated by Caprio (1957) ‘that the vast majority of lesbians are emotionally unstable and neurotic …’ is a view commonly held as true almost by definition in psychiatric circles. It might be that this type of observation has been too subjectively made, on the basis of psychiatric interviews of otherwise neurotic women, who also may have been homosexually inclined.

This paper reports relationships between symptoms and premorbid personality in a varied sample of depressed patients. Symptoms were rated by a psychiatrist at clinical interview; personality was rated by patients on self-report after clinical improvement, using the Maudsley Personality Inventory and an inventory of obsessive, hysterical and oral personality. Additional ratings on the latter were obtained at interview with a relative. The most prominent finding was that patients with premorbid neuroticism also showed a neurotic rather than an endogenous symptom pattern. Additional relationships were relatively weak but consistent with previous studies. Depressives with neurotic rather than endogenous symptom pattern showed more evidence of oral dependent personality and less obsessionality. Patients with hysterical personalities tended to be less severely ill and to show a pattern characterized by mixed depression and hostility with less evidence of anxiety.

Multimorbidity - the co-occurrence of two or more long-term conditions in an individual - is highly relevant to psychiatry. Changes to training and a more integrated model of psychiatric and physical healthcare are needed in the future if we are to improve the long-term health of our patients.

The effects of moclobemide (300–600 mg/day), a reversible monoamine oxidase inhibitor – A (MAOI-A), were compared in a double-blind, multi-centre trial with those of clomipramine (100–200 mg/day) on 129 in-patients suffering from endogenous depression (according to ICD–9 and the Newcastle Scale). No significant differences in efficacy were seen between the two treatment groups. In the moclobemide group the mean scores on the MADRS were 36.4 on day 0 and 13.2 on day 42 (end-point analysis); scores were 37.4 and 10.9 respectively in the clomipramine group. An earlier onset of antidepressant activity was noted for moclobemide. Tolerability was significantly better for moclobemide, as shown by the Clinical Global Impression of Tolerance (CGIT). Anticholinergic effects, weight gain and orthostatic hypotension were more frequent in the clomipramine group. No biological treatment-related changes were observed.

A number of studies have suggested that psychiatric syndromes differ in the socio-cultural factors with which they are associated, such as age, race, social class and religion, as well as in the patients' family and personal backgrounds.

Background Pharmacotherapy for obsessive-compulsive disorder (OCD) was seldom beneficial before clomipramine, a potent selective serotonin reuptake inhibitor (SSRI), became available. Subsequent progress in pharmacotherapy for OCD has increased the possibility of effective treatment for most sufferers.

Method Randomised controlled trials of pharmacotherapy for OCD were reviewed, as well as reports of beneficial pharmacotherapy found in open trials and case reports.

Results SSRIs are well-tolerated by patients with OCD, even in large doses. Prose roto n erg i c augmentation is seldom helpful but antipsychotic augmentations seem beneficial for many OCD patients with comorbid tics.

Conclusions Potent SSRIs are the pharmacotherapy of choice for OCD, with a more limited role reserved for monoamine oxidase inhibitors. If one SSRI is ineffective, others may be beneficial. Non-drug therapies are also important in OCD: behaviour therapy is frequently helpful but infrequently available and neurosurgery is sometimes helpful when all other treatments have failed.

Fifty-six consecutively admitted elderly (65 and over) patients with depression were assessed on mental, physical and social states. They were followed up and assessed at home one year later. A group of 24 depressed in-patients aged under 65 years admitted to the same ward during the same period was also assessed. Outcome was different for the two groups, with 68% of the elderly ‘well’ at one year, against 50% of the younger group. The younger group were more likely to have ‘poor’ outcome (41 %) than the elderly (16%). However, there were more deaths than expected, particularly in the elderly. These findings differ from some previous studies, and indicate an excellent prognosis for depression in the elderly. Outcome in younger patients is less good.

Computerized assessment which is objective, standardized and easily repeated has been shown to be acceptable to general psychiatric patients. Fifty-three subjects (43 phobics and 10 normals feigning phobias) showed no unusual apprehension in approaching this novel procedure; all were able to complete the computer interview. Furthermore, half of them claimed that they found the interview more acceptable and found it easier to communicate with the computer than with a clinician. Only nine patients preferred the clinician. The reasons for this are discussed.

The primary basis for the action of neuroleptic drugs has been suggested to be a blockade of D2 receptors in the mesolimbic system, with subsequent decrease in the firing rate of ventral tegmental (A10) dopamine neurons by the process of depolarisation inactivation (Matthyssee, 1974; Bunney et al, 1991). The main evidence for this hypothesis is that: the affinities for the D2 receptor of all effective antipsychotic drugs are positively correlated with their average clinical dose (Seeman & Lee, 1975; Creese et al, 1976); and chronic administration of antipsychotic drugs produces nearly complete inhibition of the firing of ventral tegmental (A10) dopamine neurons that project to the limbic forebrain (Chiodo & Bunney, 1983). Clozapine, the prototypical atypical antipsychotic drug, also satisfies both criteria (Seeman & Lee, 1975; Chiodo & Bunney, 1985). However, the demonstration that clozapine is more effective than other neuroleptics for the treatment of both schizophrenic patients who are responsive to typical neuroleptics (Meltzer, 1992) as well as those who are resistant (Kane et al, 1988) suggests that this simple dopamine hypothesis of neuroleptic drug action is insufficient. Indeed, there is evidence that clozapine at clinically effective doses produces less D2 receptor occupancy and, hence, less antagonism of D2 receptors in the striatum, and probably also in the limbic system, than typical neuroleptic drugs (Farde et al, 1992); this further challenges the adequacy of the dopamine hypothesis to explain the greater efficacy of clozapine. This leaves the need to consider what else besides a D2 receptor blockade may explain the action of clozapine and, indeed, whether limited blockade is superior to a more complete one.

Background The concept that early intervention with antipsychotic medications improves the long-term course of schizophrenia is discussed.

Method This report reviews the literature concerning early intervention with antipsychotic medications for people with firstepisodes, and how it affects long-term morbidity. It also studies the effects of discontinuing antipsychotic medications on relapse for people with first episodes.

Results Early intervention with antipsychotic medications appears to decrease the long-term morbidity of schizophrenia.

Conclusions Early intervention with antipsychotic medications should be encouraged for people experiencing their first episode of schizophrenia. This report proposes that studying the various phases of subject response to treatment can be helpful in elucidating when antipsychotic medications should be tapered or withdrawn.